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The best earning opportunities for doctors

On average, medical students today graduate with more than $200,000 in medical school debt and $250,000 in total educational debt. That burden makes a specialty’s earning potential an important consideration when choosing a specialty and where to practice it. The following data from the Doximity and Curative Talent 2023 Physician Compensation Report may help in making those decisions...Read more

10 specialties with the highest average compensation:

1. Neurosurgery - $788,3132. Thoracic Surgery - $706,7553. Orthopaedic Surgery - $624,0434. Plastic Surgery - $571,3435. Vascular Surgery - $557,6326. Oral & maxiofacial Surgery - $556,6427. Radiation Oncology - $547,0268. Cardiology - $544,2019. Urology - $505,74510. Radiology - $503,464

Should earning potential be a big factor in choosing a specialty?

Vigorous Exercise Not Harmful With Hypertrophic Cardiomyopathy

WEDNESDAY, May 24, 2023 (HealthDay News) -- Among individuals with hypertrophic cardiomyopathy (HCM), vigorous exercise is not associated with a higher rate of death or life-threatening arrhythmias such as resuscitated sudden cardiac arrest, arrhythmic syncope, or appropriate shock, according to a study published online May 17 in JAMA Cardiology.

Rachel Lampert, M.D., from Yale University in New Haven, Connecticut, and colleagues assessed whether vigorous exercise is associated with an increased risk for mortality or ventricular arrhythmia in individuals with HCM. The analysis included 1,660 individuals seen at 42 high-volume HCM centers.

The researchers found that among the 699 individuals (42 percent) who participated in vigorous-intensity exercise, 4.6 percent reached the composite end point of death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator. Individuals engaging in vigorous exercise did not experience a higher rate of events compared with the nonvigorous group (adjusted hazard ratio, 1.01; 95 percent one-sided confidence level, 1.48, which was below the prespecified boundary of 1.5 for noninferiority).

"These data may inform discussion between the patient and their expert clinician around exercise participation," the authors write.

Several authors disclosed financial ties to industry.

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COVID-19 Plus Heart Attack Tied to Higher Mortality and Complications

TUESDAY, June 13, 2023 (HealthDay News) -- Patients with COVID-19 and acute myocardial infarction (AMI) experienced higher rates of mortality and complications than patients without COVID-19, with racial disparities identified, according to a study scheduled to be published in the September issue of Current Problems in Cardiology.

Amer Muhyieddeen, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues assessed COVID-19's impact on racial disparities in AMI management and outcomes. Analysis included data from the first nine months of the COVID-19 pandemic, captured in the 2020 National Inpatient Sample data.

The researchers found that patients with concurrent AMI and COVID-19 had higher in-hospital mortality (adjusted odds ratio [aOR], 3.19), increased mechanical ventilation (aOR, 1.90), and higher initiation of hemodialysis (aOR, 1.38) versus patients without COVID-19. Compared to White patients, Black and Asian/Pacific Islander patients had higher in-hospital mortality (aOR, 2.13 and 3.41, respectively). Black, Hispanic, and Asian/Pacific Islander patients had higher odds of starting hemodialysis (aOR, 5.48, 2.99, and 7.84, respectively). Furthermore, they were less likely to receive percutaneous coronary intervention for AMI (aOR, 0.71, 0.81, and 0.82, respectively). Coronary artery bypass grafting was less likely among Black patients (aOR, 0.55).

"There are four main ways to address these disparities, which include improving access; providing culturally sensitive care; addressing social determinants of health; and policy changes," senior author Martha Gulati, M.D., also from Cedars-Sinai Medical Center, said in a statement.

One author disclosed ties to Novartis and Esperion.

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PCPs Provide Most of the Care Related to Life's Essential 8

THURSDAY, April 18, 2024 (HealthDay News) -- Primary care is the dominant source of care for Life's Essential 8 (LE8), according to a research letter published online March 25 in Circulation: Cardiovascular Quality and Outcomes.

Michael E. Johansen, M.D., from OhioHealth in Columbus, and colleagues sought to determine the amount of care for LE8 that is performed by primary care, given its role in access, screening, and prevention. The analysis included data from 68,062 participants (older than 17 years) in the Medical Expenditure Panel Survey (2017 to 2019).

The researchers found that rates of meeting the LE8 measures varied from 3.8 percent for tobacco treatment to 52.9 percent for those who received a medical checkup. Across all LE8 measures, primary care alone was the most involved in LE8-related care, ranging from 43.1 percent of people with tobacco use to 69.2 percent of people who received tobacco treatment. The combination of cardiology and primary care together cared for 4.5 percent with tobacco use (the lowest measure) to up to 19.2 percent of statin users. Cardiology alone was associated with care of 1.3 percent of tobacco users to 3.9 percent of statin users. Many people saw neither primary care nor cardiology (51.1 percent of tobacco users).

"Supporting primary care in their core functions of preventive care and chronic management will be key to achieving cardiovascular health," the authors write.

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High, Long-Term Consumption of Caffeine May Pose Cardiovascular Risk

Long-term, daily intake of high levels of caffeine impacts recovery of heart rate and blood pressure following physical exertion, according to a study presented at ACC Asia 2024, the joint meeting of the American College of Cardiology and the Cardiological Society of India, held from Aug. 16 to 18 in Delhi, India.

Nency Kagathara, M.B.B.S., from Zydus Medical College and Hospital in Dahod, India, and colleagues assessed the effects of long-term caffeine consumption on recovery of heart rate and blood pressure. The analysis included 92 normotensive, healthy individuals aged 18 to 45 years.

The researchers found that 19.6 percent of participants consumed >400 mg of caffeine daily. Higher daily caffeine intake (>400 mg) was more common among women, individuals employed in business and management roles, and those living in urban areas. Following the three-minute step test, significantly elevated heart rates (100/minute) and blood pressures (>140/90 mm Hg) were seen after five minutes of rest in participants who consumed >600 mg of caffeine daily.

"Due to its effect on the autonomic nervous system, regular caffeine consumption could put otherwise healthy individuals at risk of hypertension and other cardiovascular events," Kagathara said in a statement. "Increasing awareness of these risks is vital to improve heart health for all."

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Accelerated Pacing Improves Quality of Life in HFpEF Patients

TUESDAY, Feb. 7, 2023 (HealthDay News) -- Treatment with a moderately accelerated personalized backup pacing rate (myPACE) is beneficial for patients with stage B and C heart failure with preserved ejection fraction (HFpEF), according to a study published online Feb. 1 in JAMA Cardiology.

Margaret Infeld, M.D., from the University of Vermont Larner College of Medicine in Burlington, and colleagues examined the effects of a moderately accelerated personalized backup heart rate compared to 60 bpm (usual care) in a blinded trial involving patients with stage B and C HFpEF. Participants were randomly assigned to personalized accelerated pacing or usual care (50 and 57 patients, respectively) and were followed for one year.

The researchers found that the median pacemaker-detected heart rate was 75 and 65 bpm in the personalized accelerated pacing arm and usual care arm, respectively. There was an improvement in the Minnesota Living with Heart Failure Questionnaire scores in the personalized accelerated pacing group at one month and one year, while the usual care group had a worsening in scores. Improved changes were also seen in N-terminal pro-brain natriuretic peptide levels, activity levels, and device-detected atrial fibrillation in the personalized accelerated pacing group compared with usual care during follow-up of one year. Adverse clinical events occurred in four and 11 patients in the personalized accelerated pacing group and usual care group, respectively.

"The myPACE study supports the concept of heart rate modulation as a therapeutic intervention in HFpEF and provides additional evidence that moderately higher, and not lower, heart rates are beneficial in this complex patient population," the authors write.

Several authors disclosed ties to Medtronic, including one author who had a patent for pacemakers for HFpEF licensed to Medtronic.

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Factory Noise Tied to Higher Blood Pressure in Workers

There is an independent association between noise exposure duration and elevated blood pressure in factory workers, according to a study presented at ACC Asia 2024, the joint meeting of the American College of Cardiology and the Cardiological Society of India, held from Aug. 16 to 18 in Delhi, India.

Golam Dastageer Prince, M.B.B.S., M.P.H., from the Directorate of General of Health Services in Dhaka, Bangladesh, and colleagues investigated the association between occupational noise exposure duration and blood pressure among rural adult power loom weavers. The analysis included interviews with 289 adult factory workers.

The researchers found that workplace exposure duration averaged 15.97 years, with noise intensity ranging from 96 to 111 dB (mean, 105.45 dB). The prevalence of hypertension was 31.5 percent, with 53.3 percent fitting the criteria for prehypertension. There were positive correlations observed between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and noise exposure duration. SBP and DBP were predicted by linear regression for noise exposure duration. After adjusting for age, body mass index, and smoking status, each year of noise exposure increased the odds of hypertension by 10 percent (adjusted odds ratio, 1.1).

"As the study focused on workers exposed to more than 85 dB noise for long periods of time, any profession causing workers to experience similar exposure might experience similar blood pressure impacts," Prince said in a statement. "We definitely need more exploratory studies to reveal more information about the potential mechanisms and long-term health outcomes."

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ADA: Semaglutide Similarly Effective in Men, Women With Obesity-Linked Heart Failure

For patients with obesity-related heart failure with preserved ejection fraction (HFpEF), semaglutide reduces body weight to a greater extent in women but yields similar improvements in heart failure-related symptoms in men and women, according to a study published online June 23 in the Journal of the American College of Cardiology to coincide with the annual meeting of the American Diabetes Association, held from June 21 to 24 in Orlando, Florida.

Subodh Verma, M.D., Ph.D., from the University of Toronto, and colleagues examined the baseline characteristics and treatment effect of semaglutide by sex across the STEP-HFpEF program. Patients with heart failure, left ventricular ejection fraction ≥45 percent, body mass index ≥30 kg/m2, and Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) <90 points were randomly assigned to receive once-weekly semaglutide 2.4 mg or matched placebo for 52 weeks. Data were included for 1,145 patients (49.7 percent female).

The researchers found that regardless of sex, semaglutide improved KCCQ-CSS (mean difference in women and men, +7.6 and +7.5, respectively), but reduced body weight more in women than men (mean difference, −9.6 and −7.2 percent, respectively). In both sexes, semaglutide improved six-minute walk distance (6MWD) and the hierarchical composite end point comprising all-cause death, heart failure events, changes in KCCQ-CSS, and 6MWD. Compared with placebo, there were fewer serious adverse events with semaglutide.

"Despite greater reductions in weight in females than males, semaglutide produced similar, clinically meaningful improvements in heart failure-related symptoms, physical limitations, and exercise function, along with reductions in inflammation and natriuretic peptides, regardless of sex," the authors write.

Several authors disclosed ties to biopharmaceutical companies, including Novo Nordisk, which manufactures semaglutide and funded the study.

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Menopausal Transition Linked to Adverse Changes in Lipoprotein Profile

Menopausal status is associated with adverse changes in lipoprotein profiles, according to a study presented at the European Society of Cardiology Congress 2024, held from Aug. 30 to Sept. 2 in London.

Stephanie Moreno, M.D., from the University of Texas Southwestern in Dallas, and colleagues examined changes in lipid measures through the menopause transition using data from the Dallas Heart Study (DHS). Women with known menopausal status who underwent nuclear magnetic resonance LipoProfile lipid platform analysis at DHS-I and DHS-II were included. Data were analyzed for 440 premenopausal women, 298 perimenopausal women, 508 postmenopausal women, and 1,364 men.

The researchers found that women experienced a greater change in low-density lipoprotein (LDL) particles from DHS-I to DHS-II compared with men; premenopausal and perimenopausal women had the greatest change. Compared with men, postmenopausal women had a greater reduction in high-density lipoprotein (HDL) particles between DHS-I and DHS-II. Greater change in small-dense LDL was seen for women versus men, with the most pronounced changes in perimenopausal women. Significantly greater reductions in large HDL were seen in perimenopausal and postmenopausal women compared with men; no difference was seen in the change in large HDL between premenopausal women and men.

"We found that menopause is associated with adverse changes in lipoprotein profiles, with the most pronounced changes found to be in increases in 'bad' LDL-particles and subfractions observed for perimenopausal women," Moreno said in a statement. "When looked at together, these changes could help explain the increase of cardiovascular disease in postmenopausal women and help determine if earlier interventions are warranted."

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Substantial Mortality Benefits Expected From Optimal Medication Use for HFrEF

For individuals with heart failure with reduced ejection fraction (HFrEF), substantial mortality benefits would result from optimal use of guideline-directed medical therapy (GDMT), according to a study published online Oct. 2 in JAMA Cardiology.

Amber B. Tang, M.D., from the University of California Los Angeles, and colleagues examined the projected population-level benefit of optimal GDMT use globally among patients with HFrEF based on data derived from previously published studies.

Overall, 8,235,063 of an estimated 28.89 million people worldwide with HFrEF were potentially eligible for but not receiving β-blockers; 20,387,000 were eligible for but not receiving angiotensin receptor-neprilysin inhibitors; 12,223,700 were eligible for but not receiving mineralocorticoid receptor antagonists; and 21,229,170 were eligible for but not receiving sodium glucose cotransporter-2 inhibitors. The researchers found that 1,188,277 deaths could potentially be prevented over 12 months with optimal implementation of quadruple GDMT. Many of these deaths were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.

"Although future studies are needed to better understand the heterogeneity that exists within each region and potential interventions targeted to different settings, these findings demonstrate the urgent need for improved implementation of GDMT therapies worldwide," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Guidelines Developed for Management of Hypertrophic Cardiomyopathy

THURSDAY, May 9, 2024 (HealthDay News) -- In a new clinical guideline issued by the American College of Cardiology and the American Heart Association and published online May 8 in the Journal of the American College of Cardiology and Circulation, recommendations are presented for the management of patients with hypertrophic cardiomyopathy (HCM).

Steve R. Ommen, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a comprehensive literature review to develop recommendations for guiding clinicians in the management of HCM.

The authors note that shared decision-making is necessary for providing the best clinical care. For optimizing care, referral to multidisciplinary HCM centers with appropriate expertise can be important, although the primary cardiology team can initiate evaluation, treatment, and longitudinal care. Cornerstones of care include careful ascertainment of family history, counseling about the potential for genetic transmission, and options for genetic testing. One important component of management is assessing a patient's risk for sudden cardiac death. The risk factors for sudden cardiac death carry different weights and components for children versus adults with HCM. For patients with symptomatic obstructive HCM, cardiac myosin inhibitors are now available for treatment. These agents can be beneficial for patients who do not derive adequate symptom relief from first-line drug therapy. Exercise stress testing is helpful for determining exercise tolerance. Data affirm that the beneficial effects of exercise on general health apply to HCM.

"Incorporating the most recent data, this new guideline equips clinicians with the latest recommendations for the treatment of HCM," Ommen said in a statement. "We're seeing more evidence that patients with HCM can return to their normal daily lives with proper care and management."

Several authors disclosed ties to the pharmaceutical and medical device industries.

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Early Dapagliflozin Does Not Impact Diuretic Efficiency in Acute Heart Failure

THURSDAY, May 9, 2024 (HealthDay News) -- For patients with acute heart failure (AHF), early initiation of dapagliflozin does not affect diuretic efficiency, according to a study published in the April 9 issue of the Journal of the American College of Cardiology.

Zachary L. Cox, Pharm.D., from the Lipscomb University of Pharmacy in Nashville, Tennessee, and colleagues examined the diuretic efficacy and safety of early dapagliflozin initiation in AHF in a multicenter trial involving 240 patients. Within 24 hours of hospital presentation for hypervolemic AHF, patients were randomly assigned to dapagliflozin 10 mg once daily or structured usual care with protocolized diuretic titration until day 5 or hospital discharge. The primary outcome of diuretic efficiency was compared across treatment assignment.

The researchers observed no difference between the groups in diuretic efficiency. Reduced loop diuretic doses were seen in association with dapagliflozin (560 versus 800 mg), and there were fewer intravenous diuretic up-titrations to achieve weight loss equivalent to usual care. Diabetic, renal, and cardiovascular safety events were not increased with early dapagliflozin initiation. Improved median 24-hour natriuresis and urine output were seen in association with dapagliflozin, expediting hospital discharge during the study period.

"Dapagliflozin was not associated with a statistically significant reduction in weight-based diuretic efficiency but was associated with evidence for enhanced diuresis among patients with AHF," the authors write.

Several authors disclosed ties to pharmaceutical companies, including AstraZeneca, which manufactures dapagliflozin and funded the study.

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Physical Activity May Cut Heart Failure Risk in Women

FRIDAY, Feb. 23, 2024 (HealthDay News) -- Higher levels of physical activity (PA) are associated with a lower risk for heart failure in older women, according to a study published online Feb. 21 in JAMA Cardiology.

Michael J. LaMonte, Ph.D., M.P.H., from University at Buffalo–SUNY in New York, and colleagues examined whether accelerometer-measured PA and sedentary behavior are associated with incident heart failure in older women. The analysis included data from 5,951 women aged 63 to 99 years followed for a mean 7.5 years.

The researchers found that in a fully adjusted analysis, a 1-standard deviation increase in minutes of total PA per day was associated with a lower risk for overall heart failure and heart failure with preserved ejection fraction, but not heart failure with reduced ejection fraction. Similar results were seen for steps per day. An inverse relationship was seen for minutes per day of total sedentary time. Both light PA and moderate-to-vigorous PA were inversely associated with overall heart failure and heart failure with preserved ejection fraction but not heart failure with reduced ejection fraction. Across age, race and ethnicity, body mass index, physical function, or comorbidity score, results were similar.

"Results suggest that promoting regular PA and minimal sedentary time in older women may be prudent for primary prevention of heart failure and its subtype with preserved ejection fraction for which treatment is limited," the authors write.

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Kidney Dysfunction Linked to Heart Failure With Preserved Ejection Fraction

WEDNESDAY, Dec. 20, 2023 (HealthDay News) -- Mild and moderate kidney dysfunction are associated with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF), according to a study published online Nov. 27 in ESC Heart Failure.

Robin W.M. Vernooij, Ph.D., from Utrecht University in the Netherlands, and colleagues examined the association between kidney dysfunction and left ventricular diastolic dysfunction parameters and HFpEF. Estimated glomerular filtration rate (eGFR) was calculated based on creatinine and cystatin C without race. Multivariable adjusted regression models were used to test the association between eGFR and E/e', left ventricular mass index, relative wall thickness, and stage C/D heart failure. Data were included for 880 participants with a mean age of 62.9 years; 406 participants had mild or moderate kidney dysfunction (37.6 and 8.5 percent, respectively).

The researchers found that the prevalence of HFpEF was significantly higher in those with mild and moderate kidney dysfunction versus those with normal kidney function (10.3 and 16.0 percent, respectively, versus 3.4 percent). There was an association observed for higher E/e' and higher relative wall thickness values with a lower kidney function. Compared with those with normal kidney function, those with moderate kidney dysfunction had a higher likelihood of American College of Cardiology/American Heart Association stage C/D heart failure (odds ratio, 2.07).

"We found an association between moderate and mild kidney dysfunction, and diastolic dysfunction and HFpEF, independent of other risk factors," the authors write. "This association was already present for mild kidney dysfunction, and stronger for moderate kidney dysfunction."

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Inflammatory Bowel Disease Tied to Higher Risk for Heart Disease

Male patients with inflammatory bowel disease (IBD) face a higher risk for ischemic heart diseases (IHDs), according to a study published in the March issue of the International Journal of Cardiology Cardiovascular Risk and Prevention.

Noa Cohen-Heyman and Gabriel Chodick, Ph.D., both from Tel Aviv University in Israel, investigated the association between IBD and long-term risk for IHD. The analysis included 14,768 patients diagnosed with IBD (from January 1990 to July 2021; 6,144 with ulcerative colitis and 8,624 with Crohn disease) and 120,338 matched individuals without IBD.

The researchers found that during a mean follow-up of 10.5 years, 1.9 percent of participants with IBD and 1.0 percent of the reference group experienced a composite outcome of IHD, myocardial infarction, undergoing percutaneous coronary intervention, or undergoing coronary artery bypass grafting (composite hazard ratio [HR], 1.98). A higher risk for IHD was associated with IBD only in male patients (HR, 1.82), whereas a negative association was seen among female patients (HR, 0.72). When limiting analyses to patients with Crohn disease, patients with ulcerative colitis, patients on steroids, and patients on immunosuppressants, results were similar.

"High-risk individuals could be evaluated for early biomarkers predictive of future IHD, such as high-sensitive cardiac troponin, potentially making them candidates for preventive interventions, including daily aspirin administration," the authors write.

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Exercise-Induced Muscle Injury No Worse for Symptomatic Statin Users

MONDAY, April 3, 2023 (HealthDay News) -- Individuals with statin-associated muscle symptoms do not have worse exercise-induced muscle injury after prolonged moderate-intensity exercise, according to a study published in the April 11 issue of the Journal of the American College of Cardiology.

Neeltje A.E. Allard, M.D., from the Radboud University Medical Center in Nijmegen, Netherlands, and colleagues examined the effect of prolonged moderate-intensity exercise on markers of muscle injury in statin users with and without statin-associated muscle symptoms (35 and 34 participants, respectively) and in 31 controls. Participants walked 30, 40, or 50 km/day for four consecutive days. Markers of muscle injury, muscle performance, and reported muscle symptoms were examined at baseline and after exercise.

The researchers found that at baseline, all muscle injury markers were comparable and they increased following exercise, with no difference between the groups observed in terms of the magnitude of exercise-induced elevations. Symptomatic statin users had higher muscle pain scores at baseline, but scores increased similarly in all groups following exercise. Compared with control participants, symptomatic statin users had a greater increase in muscle relaxation time following exercise. Symptomatic and asymptomatic statin users and control participants had no difference in leukocyte coenzyme Q10 levels, which were measured at baseline; levels were not related to muscle injury markers, fatigue resistance, or reported muscle symptoms.

"This study demonstrated that habitually active statin users can engage in prolonged moderate-intensity exercise without exacerbating skeletal muscle injury and reinforces the recommendation to combine statin therapy with a physically active lifestyle," the authors write.

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Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

A comprehensive systematic review and meta-analysis was conducted to assess the diagnostic accuracy and prognostic value of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain. The study aimed to provide contemporary quantitative data on the topic and shed light on the low-risk period for adverse cardiovascular (CV) events after a negative stress CMR result. A total of 64 studies involving 74,470 patients were included in the analysis, with data obtained from PubMed, Embase, Cochrane Database of Systematic Reviews, PROSPERO, and ClinicalTrials.gov.

The findings revealed that stress CMR exhibited high diagnostic accuracy, with a sensitivity of 81% and specificity of 86% for detecting functionally obstructive coronary artery disease. The presence of stress-inducible ischemia and late gadolinium enhancement (LGE) were associated with higher all-cause mortality, CV mortality, and major adverse cardiovascular events (MACEs). Subgroup analysis indicated that stress CMR had even higher diagnostic accuracy when suspected coronary artery disease was present or when 3-T imaging was used. Importantly, patients with normal stress CMR results had a lower risk of MACEs for at least 3.5 years after the test...Read more

Could this be a feasible routine investigation for stable chest pain?

Wait Time Disparities Increased for VA Care During the Pandemic

MONDAY, Jan. 30, 2023 (HealthDay News) -- Black and Hispanic veterans experienced greater access barriers to care compared with their White counterparts during the COVID-19 pandemic, according to a study published online Jan. 23 in JAMA Network Open.

Deborah Gurewich, Ph.D., from the Veterans Affairs Boston Healthcare System, and colleagues assessed whether wait times increased differentially for Black and Hispanic versus White veterans from the pre-COVID-19 to the COVID-19 period. The analysis included data from 1.16 million veterans identified from the VA Corporate Data Warehouse for fiscal years 2019 to 2021 (Oct. 1, 2018, to Sept. 30, 2021).

The researchers observed significant wait time disparities for orthopedic services (e.g., Black veterans had wait times 2.09 days longer than White veterans) in the pre-COVID-19 period. There were no significant differences seen for cardiology services. There were increases in mean wait times observed from the pre-COVID-19 period to the COVID-19 period for both services among all three racial and ethnic groups (e.g., Hispanic wait times for cardiology services increased 5.09 days). For Black veterans (4.10 days) and Hispanic veterans (4.40 days), wait time disparities increased significantly from the pre-COVID-19 period to the COVID-19 period compared with White veterans (3.75 days). During COVID-19, significant wait time disparities were still evident for orthopedic services (e.g., Hispanic veterans had wait times 1.98 days longer than White veterans), but not for cardiology services. Wait time ratios significantly varied across the 140 facilities, but only six facility wait time ratios were significant during the pre-COVID-19 period versus 26 during the COVID-19 period.

"Any wait time disparity is concerning, and it will be important for future work to monitor these trends, understand their sources, and implement appropriate interventions as needed," the authors write.

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